脊髓麻醉联合吗啡用于大型关节置换术后的恶心和呕吐：次催眠剂量丙泊酚输注预防的随机试验
Nausea and vomiting after major arthroplasty with spinal anaesthesia including morphine: a randomised trial of subhypnotic propofol infusion as prophylaxis.
作者信息
Grattidge P
机构信息
Department of Anaesthesia, General Hospital, Oskarshamn, Sweden.
出版信息
Acta Anaesthesiol Scand. 1998 Jan;42(1):124-7. doi: 10.1111/j.1399-6576.1998.tb05092.x.
BACKGROUND
Postoperative nausea and vomiting (PONV) following major arthroplasty with spinal anaesthesia and intrathecal morphine is reported in 45-74% of patients. This randomised, double-blind, placebo-controlled trial was undertaken to determine whether a subhypnotic infusion of propofol has a prophylactic antiemetic effect in this patient population.
METHODS
82 patients undergoing hip or knee replacement under subarachnoid bupivacaine anaesthesia plus morphine 0.25 mg were randomised at the end of surgery to receive either propofol 30 mg x h(-1) or fat emulsion (Intralipid) 3 ml x h(-1) for 20 h postoperatively. Blinded observers recorded episodes of nausea, vomiting and pruritus.
RESULTS
PONV in the intervention group was 40% vs 59% in the controls (P=0.1, not significant). Pruritus occurred in 34%, with a similar rate in both groups.
CONCLUSION
These results suggest that routine use of postoperative, subhypnotic propofol infusion as PONV prophylaxis is not justified in this patient population.
背景
据报道，在接受脊髓麻醉和鞘内注射吗啡的大关节置换术后，45%至74%的患者会出现术后恶心呕吐（PONV）。本随机、双盲、安慰剂对照试验旨在确定亚催眠剂量输注丙泊酚对该患者群体是否具有预防性抗呕吐作用。
方法
82例在蛛网膜下腔布比卡因麻醉加0.25mg吗啡下行髋关节或膝关节置换术的患者，在手术结束时随机分为两组，术后20小时分别接受30mg/h的丙泊酚或3ml/h的脂肪乳剂（英脱利匹特）输注。盲法观察者记录恶心、呕吐和瘙痒发作情况。
结果
干预组PONV发生率为40%，对照组为59%（P = 0.1，无统计学意义）。瘙痒发生率为34%，两组相似。
结论
这些结果表明，在该患者群体中，常规使用术后亚催眠剂量丙泊酚输注预防PONV是不合理的。
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